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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e318216940e
Original Articles: Gastroenterology

Inter- and Intraobserver Agreement in 24-hour Combined Multiple Intraluminal Impedance and pH Measurement in Children

Pilic, Denisa*; Höfs, Carolin*; Weitmann, Sandra; Nöh, Frank; Fröhlich, Thorsten§; Skopnik, Heino; Köhler, Henrik§; Wenzl, Tobias G.; Schmidt-Choudhury, Anjona*

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Objectives: Assessment of intra- and interobserver agreement in multiple intraluminal impedance (MII) measurement between investigators from different institutions.

Methods: Twenty-four 18- to 24-hour MII tracings were randomly chosen from 4 different institutions (6 per center). Software-aided automatic analysis was performed. Each result was validated by 2 independent investigators from the 4 different centers (4 investigator combinations). For intraobserver agreement, 6 measurements were analyzed twice by the same investigator. Agreement between investigators was calculated using the Cohen kappa coefficient.

Results: Interobserver agreement: 13 measurements showed a perfect agreement (kappa >0.8); 9 had a substantial (kappa 0.61–0.8), 1 a moderate (kappa coefficient 0.41 to 0.6), and 1 a fair agreement (kappa coefficient 0.11–0.4). Median kappa value was 0.83. Intraobserver agreement: 5 tracings showed perfect and 1 showed a substantial agreement. The median kappa value was 0.88.

Conclusions: Most measurements showed substantial to perfect intra- and interobserver agreement. Still, we found a few outliers presumably caused by poorer signal quality in some tracings rather than being observer dependent. An improvement of analysis results may be achieved by using a standard analysis protocol, a standardized method for judging tracing quality, better training options for method users, and more interaction between investigators from different institutions.

Copyright 2011 by ESPGHAN and NASPGHAN


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